Provider Demographics
NPI:1073599767
Name:BADEJO, ERHIME T (MD MSN)
Entity Type:Individual
Prefix:DR
First Name:ERHIME
Middle Name:T
Last Name:BADEJO
Suffix:
Gender:F
Credentials:MD MSN
Other - Prefix:DR
Other - First Name:ERHIME
Other - Middle Name:TEKA
Other - Last Name:OGHRE-IKANONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD MSN
Mailing Address - Street 1:305 W JACKSON ST STE 200
Mailing Address - Street 2:CARBONDALE FAMILY MEDICINE
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-1474
Mailing Address - Country:US
Mailing Address - Phone:618-536-6621
Mailing Address - Fax:618-453-1102
Practice Address - Street 1:305 W JACKSON ST STE 200
Practice Address - Street 2:CARBONDALE FAMILY MEDICINE
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-1474
Practice Address - Country:US
Practice Address - Phone:618-536-6621
Practice Address - Fax:618-453-1102
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125067577208D00000X, 207Q00000X
MO2004020321163W00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner